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Scoliosis and Spinal Disorders

Open Access

A cognitive behavioral approach allows improving brace wearing compliance: an observational controlled retrospective study with thermobrace

  • Alessandra Negrini1,
  • Sabrina Donzelli1,
  • Monia Lusini1,
  • Salvatore Minnella1,
  • Fabio Zaina1 and
  • Stefano Negrini2
Scoliosis20149(Suppl 1):O79

Published: 4 December 2014


Cohort StudyGroup ComparisonMedical DoctorIdiopathic ScoliosisPoor Adherence


Results of brace treatment of Idiopathic Scoliosis are related to brace wearing.


To verify if Cognitive Behavioural Approach (CBA) dispensed during Physiotherapic Scoliosis Specific Exercises (PSSE) sessions increases brace wearing.


Retrospective controlled cohort study nested into a clinical database.


Setting. Outpatient tertiary referral clinic.

Population. Out of 778 patients, 246 fulfilled the inclusion criteria: Idiopathic Scoliosis; first brace prescription; regular use of Thermobrace heat sensor; two evaluations after bracing; age ³6; European Risser 0-3.

Evaluations. T0 (start of bracing), T1 (4 months), T2 (10 months).

Measurements. Brace wearing compliance (BWC) T0 to T1 (T0-T1) and T1 to T2 (T1-T2).

Treatment. CBA adjunctive sessions dispensed during PSSE (CBA-PSSE), after the standard CBA provided to all patients including: at prescription, 20’ by Medical Doctor (MD) and 30-45’ by Physiotherapist; at brace check, 10-15’ by MD and Orthopaedic Technician; at T1, 10-15’ by MD.

Groups. According to CBA-PSSE in T0-T1 period: CBA1 (143 patients) ³2 sessions; Poor-Adherence (PA1, 52) 1 session; Control (CON1, 51) 0 sessions . Similarly, according to CBA-PSSE in T1-T2 period: CBA2 (97),PA2 (78), CON2 (71). Combinations among the 6 groups in the two periods were checked.

Statistics. ANOVA for group comparisons.


Patients were 13.03±1.11 years old. Brace hours prescription: 21.93±1.77 (T0-T1), 21.03±1.79 (T1-T2). BWC: 91.06±12.63% (T0-T1), 91.64±14.3% (T1-T2).

We found no differences among groups in brace prescription and BWC in T0-T1.

In T1-T2:

CBA1 had more brace prescription than CON1 (P<0.01);

CBA1 and CON1 improved BWC more than PA1 (P<0.005);CBA2 and CON2 improved BWC more than PA2; patients who were both in CBA1 and in CBA2, had more hours of brace prescription than PA2 and CON2, and improved brace compliance more than PA2 (P<0.05).

Overall, BWC differences among groups reached a maximum of 7%.


CBA improves BWC: specifically, patients with high CBA-PSSE in both observed periods (CBA1+CBA2) had both the highest brace hours prescription and the highest BWC. Poor adherence to CBA-PSSE matched with poor adherence to brace wearing.

Authors’ Affiliations

ISICO - Italian Scientific Spine Institute, Milan, Italy
University of Brescia - IRCCS Don Gnocchi, Brescia, Italy


© Negrini et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.